本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-076388

摘要内容如下：

客观

探讨非酒精性脂肪性肝病（NAFLD）对2型糖尿病（T2DM）患者心血管疾病和全因死亡的风险。

设计

基于全国人口的研究。

设置

韩国纵向队列研究。

参与者

7796763名参加2009年国家健康筛查计划的参与者根据NAFLD状况分为三组：无NAFLD（脂肪肝指数<30）；1级NAFLD（30≤脂肪肝指数<60）；2级NAFLD（脂肪肝指数≥60）。中位随访时间为8.13年。

主要结果指标

主要转归是心血管疾病事件（心肌梗死、缺血性卒中）或全因死亡。

结果

在7796763名参与者中，6.49%（n=505763）患有T2DM。1级NAFLD（34.06%）和2级NAFLD（26.73%）的T2DM患者多于非T2DM患者（1级NAFLD:21.20%；2级NAFLD:10.02%）。心血管疾病和全因死亡的发生率（每1000人年）按无NAFLD、1级NAFLD、2级NAFLD的顺序递增，且T2DM患者的发生率高于无T2DM患者。在无T2DM和有T2DM的患者中，心血管疾病和全因死亡的5年绝对风险按无NAFLD、1级NAFLD和2级NAFLD的顺序增加（无NAFLD，无T2DM:1.03，95%可信区间分别为1.02-1.04和1.25，1.24-1.26；1级NAFLD，无T2DM：分别为1.23，1.22至1.25，和1.50，1.48至1.51；2级NAFLD，无T2DM：分别为1.42，1.40至1.45，和2.09，2.06至2.12；无NAFLD，T2DM分别为3.34、3.27~3.41和3.68、3.61~3.74；1级NAFLD，合并T2DM：分别为3.94、3.87~4.02和4.25、4.18~4.33；2级NAFLD，合并T2DM：分别为4.66，4.54至4.78和5.91，5.78至6.05）。有T2DM但无NAFLD的患者比无T2DM但有2级NAFLD的患者有更高的心血管疾病和全因死亡的5年绝对风险。无NAFLD和1级或2级NAFLD之间心血管疾病和全因死亡的风险差异在T2DM患者中高于无T2DM患者。

结论

T2DM患者的NAFLD似乎与心血管疾病和全因死亡的高风险相关，即使在轻度NAFLD患者中也是如此。无NAFLD组与1级或2级NAFLD组之间心血管疾病和全因死亡的风险差异在T2DM患者中高于无T2DM患者。

英文原文如下：

Abstracts

OBJECTIVE  To investigate the risk of non-alcoholic fatty liver disease (NAFLD) for cardiovascular disease and all cause death in patients with type 2 diabetes mellitus (T2DM).

DESIGN  Nationwide population based study.

SETTING  Longitudinal cohort study in Korea.

PARTICIPANTS  7 796 763 participants in the National Health Screening Programme in 2009 were divided into three groups based on NAFLD status: no NAFLD (fatty liver index<30); grade 1 NAFLD (30≤fatty liver index<60); and grade 2 NAFLD (fatty liver index≥60). Median follow-up was 8.13 years.

MAIN OUTCOME MEASURES  The primary outcome was incident cardiovascular disease (myocardial infarction, ischaemic stroke) or all cause death.

RESULTS  Of 7 796 763 participants, 6.49% (n=505 763) had T2DM. More patients with T2DM had grade 1 NAFLD (34.06%) and grade 2 NAFLD (26.73%) than those without T2DM (grade 1 NAFLD: 21.20%; grade 2 NAFLD: 10.02%). The incidence rate (per 1000 person years) of cardiovascular disease and all cause death increased in the order of no NAFLD, grade 1 NAFLD, and grade 2 NAFLD, and the incidence rates in patients with T2DM were higher than those in patients without T2DM. The five year absolute risk for cardiovascular disease and all cause death increased in the order of no NAFLD, grade 1 NAFLD, and grade 2 NAFLD in patients without and with T2DM (no NAFLD, without T2DM: 1.03, 95% confidence interval 1.02 to 1.04, and 1.25, 1.24 to 1.26, respectively; grade 1 NAFLD, without T2DM: 1.23, 1.22 to 1.25, and 1.50, 1.48 to 1.51, respectively; grade 2 NAFLD, without T2DM: 1.42, 1.40 to 1.45, and 2.09, 2.06 to 2.12, respectively; no NAFLD, with T2DM: 3.34, 3.27 to 3.41, and 3.68, 3.61 to 3.74, respectively; grade 1 NAFLD, with T2DM: 3.94, 3.87 to 4.02, and 4.25, 4.18 to 4.33, respectively; grade 2 NAFLD, with T2DM: 4.66, 4.54 to 4.78, and 5.91, 5.78 to 6.05, respectively). Patients with T2DM and without NAFLD had a higher five year absolute risk for cardiovascular disease and all cause death than those without T2DM and with grade 2 NAFLD. Risk differences for cardiovascular disease and all cause death between no NAFLD and grade 1 or grade 2 NAFLD were higher in patients with T2DM than in those without T2DM.

CONCLUSIONS  NAFLD in patients with T2DM seems to be associated with a higher risk of cardiovascular disease and all cause death, even in patients with mild NAFLD. Risk differences for cardiovascular disease and all cause death between the no NAFLD group and the grade 1 or grade 2 NAFLD groups were higher in patients with T2DM than in those without T2DM.

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